February 05, 2008

How Broken Bones Heal and Why, Sometimes, they Don't

Most of you regular readers know that I broke my arm on a Thanksgiving Day mountain bike ride. It was a classic " Colles fracture" of the distal radius created by extending my right arm in an attempt to break my fall into a big pile of rocks.

Well, last Friday I got some bad news.

My fracture is now officially a non- union fracture meaning it has not healed correctly and is in effect still broken.

How can this be? After all I was in a cast for seven weeks, right?

Wrong. Broken dog bones, broken cat bones and broken people bones all heal in the same way. If you can align the broken ends of the bones in reasonable proximity and immobilize them, they will grow back together over a period of time.

The process is pretty basic. The first stage right after the injury involves the formation of a blood clot and fibroblasts to form kind of an internal version of a scab that starts to hold everything together.

The second stage involves the formation of a bony callous and in the third stage this bony callous is remodeled and hardened until the fracture site is as strong as before the original injury.

That's the way it's supposed to happen. However, in some cases it doesn't go that well. If the bones are not aligned properly or if the fracture is not stabilized adequately, things can go badly. Malnutrition can also cause problems as can smoking, excessive drinking and systemic corticosteroid use.

For dogs, cats and me the smoking and drinking are not the issue. In my case I think it's a combination of factors.

I do use an inhaled corticosteroid for asthma but I think my real problem was being a bad patient. I was so focused on getting back in training for and upcoming bike race that I did things during recovery that I should not have. Even when I was in the cast I was trying to wedge a light dumbbell into my fingers to do curls. Guess dumbbell is an appropriate term in more ways than one.

Even worse, as soon as I was out of the cast I was back on my bike riding in pain and getting all the road vibration right up through the fracture site. All this activity creates micro motion at the healing fracture site and can actually impede healing and create a non-union. My doctor told me not to push it and go easy because even after seven weeks in a cast it was not completely healed.

The net result is that I go in for surgery on Wednesday followed by another six weeks in a cast. The surgery involves a titanium plate that is applied over the fracture site and held in place by screws. I have another such plate in my leg from an older bike crash but that's another story.

I plan to be a model patient and have promised to barely wiggle my fingers on the affected side. I'm also going to focus on nutrition and take both calcium and vitamin D supplements during recovery. Vitamin D is critical for calcium absorption from the intestines.

I'll also be typing one handed so posts will be short. We'll probably be doing more "Out Loud" segments too. The lesson for me is how important it is to follow your doctor's instructions. I've sure given out lots of instructions to pet owners in the past. I've just assumed people would follow them and I'm sure most have. In my case I've been thinking of an old adage a lot lately.

"Doctor, heal thyself" is one that will be echoing around my brain for the next couple of months.

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Recovery from orthopaedic surgery becomes less of a problem if one stops falling off bicycles into big piles of rocks. Your note suggests a pattern of bicycle related injuries. May I suggest a more sedate use of your time like flyfishing? I sincerely hope you have a successful recovery. Take courage eh?

I'm so honored!

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